This is Barry Bellosis, one of the musculoskeletal radiology fellows at Stanford University. 13 year old female soccer player with two months of left foot pain concerned for osteochondrosis. The patient in this case presented with this radiograph. In this foot radiograph, we can see flattening of the third metatarsal head with subchondral sclerosis as seen here. On magnified view, we can also see subchondral changes in the third metatarsal head. Osteochondrosis of the metatarsal head may be a result of a traumatic insult either in the form of acute or repetitive injury and vascular compromise. If there is concern for an infection, we look for any signs of periosteal reaction or any lytic changes. Rheumatologic disorder, on the other hand, typically presents in a polyarticular pattern and may be accompanied by marginal erosions. However, serum testing could be performed to correlate to radiographic findings. This is in a different patient showing a flattened second metatarsal head with subtle subchondral sclerosis typical of osteochondrosis involving the second metatarsal head.

2nd Edition, CASE 14

2nd Edition

Foot and Ankle

osteochondrosis

metatarsal

foot pain

radiographs

diagnosis